Crisco, James Jeffrey

Crisco, James Jeffrey is an individual health care provider with primary practice located at 3636 N 124Th St Suite 200, Wauwatosa WI 53222-2125. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical Child & Adolescent, which is considered as his primary health care specialty. Crisco, James Jeffrey can be contacted via phone (414) 476-9755.

Contact Information

Primary practice address
3636 N 124Th St Suite 200 Wauwatosa WI 53222-2125
Phone: (414) 476-9755
Fax: (414) 476-3413
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 613-057 Wisconsin

Profile Details

NPI number 1013172600
LBN Legal business name Crisco, James Jeffrey
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 23rd, 2008
Last updated Apr 22nd, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013172600 NPPES
Wisconsin MEDICAID 39010900

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